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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
_____________________________
FORM 10-Q
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934.
For the quarterly period ended September 30, 2022.
OR
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934.
For the transition period from                      to                     .
Commission file number: 001-33757
_____________________________
https://cdn.kscope.io/70c5493e2e7155b4c87bb2f53ce2ad7d-ensg-20220930_g1.jpg
THE ENSIGN GROUP, INC.
(Exact Name of Registrant as Specified in Its Charter)

Delaware33-0861263
(State or Other Jurisdiction of(I.R.S. Employer
Incorporation or Organization)Identification No.)

29222 Rancho Viejo Road, Suite 127
San Juan Capistrano, CA 92675
(Address of Principal Executive Offices and Zip Code)

(949487-9500
(Registrant’s Telephone Number, Including Area Code)
_____________________________
Securities registered pursuant to Section 12(b) of the Act:

Title of each classTrading Symbol(s)Name of each exchange on which registered
Common Stock, par value $0.001 per shareENSGNASDAQ Global Select Market

Indicate by check mark:
whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.þYesNo
whether the registrant has submitted electronically, every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files).þYesNo
whether the registrant is a large accelerated filer, an accelerated filer, non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and "emerging growth company" in Rule 12b-2 of the Exchange Act:
Large accelerated filerþAccelerated filerNon-accelerated filerSmaller reporting companyEmerging growth company
If an emerging growth company, indicate if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.YesNo
whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act).YesþNo
As of October 21, 2022, 55,484,262 shares of the registrant’s common stock, $0.001 par value, were outstanding.


Table of Contents
THE ENSIGN GROUP, INC.
QUARTERLY REPORT ON FORM 10-Q
FOR THE THREE MONTHS AND NINE MONTHS ENDED SEPTEMBER 30, 2022
TABLE OF CONTENTS

Pg.
Notes to Condensed Consolidated Financial Statements






Table of Contents
PART I.
Item 1.        FINANCIAL STATEMENTS

THE ENSIGN GROUP, INC.
UNAUDITED CONDENSED CONSOLIDATED BALANCE SHEETS
September 30, 2022December 31, 2021
(In thousands, except par values)
ASSETS  
Current assets:   
Cash and cash equivalents$308,864 $262,201 
Accounts receivable—less allowance for doubtful accounts of $7,865 and $11,213 at September 30, 2022 and December 31, 2021, respectively
353,956 328,731 
Investments—current12,233 13,763 
Prepaid income taxes15,298 5,452 
Prepaid expenses and other current assets36,497 29,562 
Total current assets726,848 639,709 
Property and equipment, net963,465 888,434 
Right-of-use assets 1,349,411 1,138,872 
Insurance subsidiary deposits and investments41,689 36,567 
Escrow deposits8,287  
Deferred tax assets33,733 33,147 
Restricted and other assets 58,469 47,046 
Intangible assets, net 2,531 2,652 
Goodwill 76,869 60,469 
Other indefinite-lived intangibles 3,972 3,727 
TOTAL ASSETS$3,265,274 $2,850,623 
LIABILITIES AND EQUITY  
Current liabilities:  
Accounts payable$63,495 $58,116 
Accrued wages and related liabilities (Note 3)
291,351 278,770 
Lease liabilities—current 60,951 52,181 
Accrued self-insurance liabilities—current47,136 40,831 
Other accrued liabilities 100,193 89,410 
Current maturities of long-term debt3,914 3,760 
Total current liabilities567,040 523,068 
Long-term debt—less current maturities150,191 152,883 
Long-term lease liabilities—less current portion 1,259,717 1,056,515 
Accrued self-insurance liabilities—less current portion77,621 69,308 
Other long-term liabilities28,957 27,135 
TOTAL LIABILITIES$2,083,526 $1,828,909 
Commitments and contingencies (Notes 16, 18 and 19)
EQUITY  
Ensign Group, Inc. stockholders' equity:
Common stock: $0.001 par value; 100,000 shares authorized; 58,833 and 55,465 shares issued and outstanding at September 30, 2022, respectively, and 58,134 and 55,190 shares issued and outstanding at December 31, 2021, respectively
58 58 
Additional paid-in capital405,555 369,760 
Retained earnings889,069 733,992 
Common stock in treasury, at cost, 3,368 and 2,944 shares at September 30, 2022 and December 31, 2021, respectively (Note 20)
(114,626)(83,042)
Total Ensign Group, Inc. stockholders' equity1,180,056 1,020,768 
Non-controlling interest1,692 946 
Total equity$1,181,748 $1,021,714 
TOTAL LIABILITIES AND EQUITY$3,265,274 $2,850,623 
See accompanying notes to condensed consolidated financial statements.
1

Table of Contents
THE ENSIGN GROUP, INC.
UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF INCOME

Three Months Ended September 30,Nine Months Ended September 30,
 2022202120222021
(In thousands, except per share data)
REVENUE
Service revenue$765,883 $664,597 $2,203,386 $1,922,482 
Rental revenue4,122 3,933 12,550 11,837 
TOTAL REVENUE$770,005 $668,530 $2,215,936 $1,934,319 
Expense:
Cost of services601,623 514,106 1,720,905 1,484,816 
Rent—cost of services 38,907 35,623 111,897 103,534 
General and administrative expense39,247 38,554 116,030 109,735 
Depreciation and amortization15,941 13,929 45,475 41,383 
TOTAL EXPENSES695,718 602,212 1,994,307 1,739,468 
Income from operations74,287 66,318 221,629 194,851 
Other (expense) income:
Interest expense(2,108)(1,709)(6,864)(4,984)
Other income (expense)276 248 (3,127)2,117 
Other expense, net(1,832)(1,461)(9,991)(2,867)
Income before provision for income taxes72,455 64,857 211,638 191,984 
Provision for income taxes16,213 16,513 47,505 43,220 
NET INCOME56,242 48,344 164,133 148,764 
Less:
Net income (loss) attributable to noncontrolling interests63 1,063 (77)2,852 
Net income attributable to The Ensign Group, Inc.$56,179 $47,281 $164,210 $145,912 
NET INCOME PER SHARE ATTRIBUTABLE TO THE ENSIGN GROUP INC.
Basic $1.02 $0.87 $3.00 $2.68 
Diluted$0.99 $0.83 $2.89 $2.56 
WEIGHTED AVERAGE COMMON SHARES OUTSTANDING
Basic54,882 54,627 54,819 54,430 
Diluted56,761 56,971 56,829 56,954 
See accompanying notes to condensed consolidated financial statements.
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THE ENSIGN GROUP, INC.
UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY
 Common Stock Additional Paid-In Capital Retained Earnings Treasury StockNon-Controlling Interest
(In thousands)Shares Amount   Shares AmountTotal
BALANCE - JANUARY 1, 202255,190 $58 $369,760 $733,992 2,944 $(83,042)$946 $1,021,714 
Issuance of common stock to employees and directors resulting from the exercise of stock options147 — 2,768 — — — — 2,768 
Issuance of restricted stock, net of forfeitures104 — 5,241 — — — — 5,241 
Shares of common stock used to satisfy tax withholding obligations— — — — — (15)— (15)
Dividends declared ($0.0550 per share)
— — — (3,042)— — — (3,042)
Employee stock award compensation— — 5,167 — — — — 5,167 
Repurchase of common stock (Note 20)
(133)— — — 133 (9,882)— (9,882)
Acquisition of noncontrolling interest shares— — 245 — — — (271)(26)
Net loss attributable to noncontrolling interest— — — — — — (252)(252)
Net income attributable to the Ensign Group, Inc.— — — 50,340 — — — 50,340 
BALANCE - MARCH 31, 202255,308 $58 $383,181 $781,290 3,077 $(92,939)$423 $1,072,013 
Issuance of common stock to employees and directors resulting from the exercise of stock options223 — 3,303 — — — — 3,303 
Issuance of restricted stock, net of forfeitures38 — — — — — — — 
Shares of common stock used to satisfy tax withholding obligations (20)— — — 20 (1,687)— (1,687)
Dividends declared ($0.0550 per share)
— — — (3,040)— — — (3,040)
Employee stock award compensation— — 5,616 — — — — 5,616 
Repurchase of common stock (Note 19)(271)— — — 271 (20,000)— (20,000)
Issuance of noncontrolling interests through subsidiary equity plan— — 6,693 — — — — 6,693 
Net income attributable to noncontrolling interest— — — — — — 112 112 
Distribution to noncontrolling interest holder and other changes— — — — — — (8)(8)
Net income attributable to the Ensign Group, Inc.— — — 57,691 — — — 57,691 
BALANCE - JUNE 30, 202255,278 $58 $398,793 $835,941 3,368 $(114,626)$527 $1,120,693 
Issuance of common stock to employees and directors resulting from the exercise of stock options151 — 2,635 — — — — 2,635 
Issuance of restricted stock, net of forfeitures36 — — — — — — — 
Dividends declared ($0.0550 per share)
— — — (3,051)— — — (3,051)
Employee stock award compensation— — 5,898 — — — — 5,898 
Acquisition of noncontrolling interest shares— — (1,774)— — — 1,105 (669)
Net income attributable to noncontrolling interest— — — — — — 63 63 
Distribution to noncontrolling interest holder and other changes— — 3 — — — (3) 
Net income attributable to the Ensign Group, Inc.— — — 56,179 — — — 56,179 
BALANCE - SEPTEMBER 30, 202255,465 $58 $405,555 $889,069 3,368 $(114,626)$1,692 $1,181,748 
3

Table of Contents

 Common Stock Additional Paid-In Capital Retained Earnings Treasury StockNon-Controlling Interest
(In thousands)Shares Amount   Shares AmountTotal
BALANCE - JANUARY 1, 202154,626 $58 $338,177 $551,055 2,791 $(71,213)$150 $818,227 
Issuance of common stock to employees and directors resulting from the exercise of stock options246 — 3,880 — — — — 3,880 
Issuance of restricted stock, net of forfeitures81 — 3,725 — — — — 3,725 
Shares of common stock used to satisfy tax withholding obligations— — — — — (9)— (9)
Dividends declared ($0.0525 per share)
— — — (2,886)— — — (2,886)
Employee stock award compensation— — 4,054 — — — — 4,054 
Net income attributable to noncontrolling interest— — — — — — 631 631 
Distribution to noncontrolling interest holder— — — — — — (1,248)(1,248)
Net income attributable to the Ensign Group, Inc.— — — 49,206 — — — 49,206 
BALANCE - MARCH 31, 202154,953 $58 $349,836 $597,375 2,791 $(71,222)$(467)$875,580 
Issuance of common stock to employees and directors resulting from the exercise of stock options148 — 2,982 — — — — 2,982 
Issuance of restricted stock, net of forfeitures49 — — — — — — — 
Shares of common stock used to satisfy tax withholding obligations(20)— — — 20 (1,600)— (1,600)
Dividends declared ($0.0525 per share)
— — — (2,894)— — — (2,894)
Employee stock award compensation— — 4,633 — — — — 4,633 
Net income attributable to noncontrolling interest— — — — — — 1,158 1,158 
Distribution to noncontrolling interest holder— — — — — — (641)(641)
Net income attributable to the Ensign Group, Inc.— — — 49,425 — — — 49,425 
BALANCE - JUNE 30, 202155,130 $58 $357,451 $643,906 2,811 $(72,822)$50 $928,643 
Issuance of common stock to employees and directors resulting from the exercise of stock options69 — 1,246 — — — — 1,246 
Issuance of restricted stock, net of forfeitures49 — — — — — — — 
Shares of common stock used to satisfy tax withholding obligations(1)— — — 1 (102)— (102)
Dividends declared ($0.0525 per share)
— — — (2,900)— — — (2,900)
Employee stock award compensation— — 5,082 — — — — 5,082 
Net income attributable to noncontrolling interest— — — — — — 1,063 1,063 
Distribution to noncontrolling interest holder— — — — — — (1,019)(1,019)
Net income attributable to the Ensign Group, Inc.— — — 47,281 — — — 47,281 
BALANCE - SEPTEMBER 30, 202155,247 $58 $363,779 $688,287 2,812 $(72,924)$94 $979,294 
See accompanying notes to condensed consolidated financial statements
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Table of Contents
THE ENSIGN GROUP, INC.
UNAUDITED CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
Nine Months Ended September 30,
(In thousands)20222021
Cash flows from operating activities:  
Net income $164,133 $148,764 
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization45,475 41,383 
Amortization of deferred financing fees770 637 
Non-cash leasing arrangement 351 346 
Write-off of deferred financing fees566  
Deferred income taxes (585)458 
Provision for doubtful accounts 2,301 2,609 
Stock-based compensation16,681 13,769 
Gain on sale of assets (3,467)(540)
Loss on insurance claims, legal finding and asset disposals5,499 695 
Change in operating assets and liabilities 
Accounts receivable (27,552)(16,606)
Prepaid income taxes(9,846)(2,912)
Prepaid expenses and other assets(8,479)(6,061)
Cash surrender value of life insurance policy premiums(5,378)(9,505)
Deferred compensation liability5,371 9,607 
Operating lease obligations215 (5,668)
Accounts payable4,878 6,332 
Accrued wages and related liabilities14,307 14,112 
Income taxes payable 357 
Other accrued liabilities5,163 (2,907)
Accrued self-insurance liabilities11,968 9,796 
Other long-term liabilities(34)(177)
NET CASH PROVIDED BY OPERATING ACTIVITIES
222,337 204,489 
Cash flows from investing activities:  
Purchase of property and equipment(59,735)(50,133)
Cash payments for business acquisitions (Note 9)
(16,400)(6,000)
Cash payments for asset acquisitions (Note 9)
(65,699)(5,183)
Escrow deposits(8,287)100 
Cash from insurance proceeds1,143 6,705 
Cash proceeds from the sale of assets8,626 951 
Purchases of investments(15,497)(26,387)
Maturities of investments11,905 23,917 
Other restricted assets173 (1,839)
NET CASH USED IN INVESTING ACTIVITIES
(143,771)(57,869)
Cash flows from financing activities:  
Proceeds from debt (Note 16)
211 31,646 
Payments on debt (Note 16)
(2,908)(2,146)
Issuance of common stock upon exercise of options8,706 8,108 
Repurchase of shares of common stock to satisfy tax withholding obligations(1,702)(1,711)
Repurchase of shares of common stock (Note 20)
(29,882) 
Dividends paid(9,118)(8,647)
Proceeds from sale of subsidiary shares (Note 7)
6,693  
Non-controlling interest distribution(11)